Transcript Angiomyolipoma of kidney

Diagnostic mistakes of
radiology visualization of
urolithiasis
M. Pasichnyk , S.Pasichnyk, A. Shulyak
Lviv National Medical University
Lviv, Ukraine
Clinical presentation
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Age: 40 years
Gender: male
Complaints: Acute renal colic.
History of disease: acutely admitted by ambulance
to the Rivne Regional Diagnostic Center
• History of life: before hospitalization this patient
had no complaints.
• Occupation: worker of the porcine farm
Results of clinical examination
• Pain in right flank, positive Merphy’s sign on the
right
• Blood cell count: Hb 122 g/L, er 3x1012/L, L
6.8x109/L, ESR 9 mm/h
• Differentional blood cell count: eosiniphilia (9%).
• Urinalysis: normal
• Blood biochemistry: normal
• Blood coagulation test: normal
Ultrasonography
Right kidney: parenchima normal, hydroureteronephrosis
to the upper third of ureter (its diameter 9 mm) without
any stone
Left kidney, liver, spleen, regional lymphatic nodes are
normal.
KUB (lumbar region)
Please note two shadows suspicious of calculus located at LI and LIII-IV
on the right side
KUB (pelvic region)
Please note two shadows located in the soft tissues above the
coxofemoral joint
Topogram of the trunk
Note the multiple system ossifications in the soft tissues
CT of trunk
There are a lot of calcificates in the muscles of back
CT with contrasting
Note the hydroureteronephrosis on the right
CT of the brain
Note foci of calcification in the brain
Conclusions of CT
Multiple calcifications of the soft tissues
Hydroureteronephrosis to the upper third of
the ureter on the right caused by the
periureteral calcification (diameter about 7
mm)
Management
• This particular patient refused from any
treatment
• Follow-up of this case was impossible
What is your diagnosis?
What additional tests would you prescribe?
What management would you suggest?
Our diagnosis
• Cystocercosis?
• Treatment: specific drugs against
cystocercosis according to the consultation
of infectionist and ureteral stenting
Similar cases from the literature
Typical oval calcified cysticercus
in muscles of a hip (Nigeria)
CT – calcified cysticercus
located in a brain near the
ventriculus, but in that patient not
causing other changes (CT with
contrasting) (Egypt)
What is cysticercosis ?
- Similarly to other parasitic diseases, cysticercosis
is caused by the use of contaminated food or
water. Sometimes autoinfection of the patient
already infected with a tape worm is noted. Unlike
in the brain (or eyes), in the visceral organs
cysticercus are surrounded by the fibrous capsule,
but remain alive for several years.
Holger Pettersson, MD
Professor of Radiology University Hospital
Lund, Sweden, 1995